A little over a month ago, I found myself back in the emergency room with my father-in-law. I am part of the sandwich generation, that age between getting kids out of the nest to start their lives and helping parents in their later years to live their lives with some grace and comfort. Powers of attorney (POA) for health care for my mother and my father-in-law have fallen squarely in my court.
Being an advocate for a senior requires more than making doctor appointments and helping to ensure the senior makes it to the appointment. That is the simple part. Some seniors may not want to press doctors regarding their care because they are afraid they will be punished by not getting the care they need. Doctors may be so busy that they will sometimes miss crucial issues on the charts in front of them or may accept non-committal answers from a senior scared to death of hospitals and ending up in a nursing home and not look deeper for the underlying cause of health issues.
This is written not to disparage the health care professionals who care for seniors. However it helps the doctor to know someone is with the senior who cares enough to know their medical history and to ask questions about problems they are experiencing. Of course, the trick is to leave the dignity of the senior intact by first letting them provide as much information to the doctor as they are willing or able to supply and to ask as many questions as occur to them.
Important Point #1: If you, as an advocate, have POA over health care, you should keep copies handy, even scanned into your computer (both at home and at work), so that if you end up in an emergency room situation, you can print a copy before leaving home or work to provide the hospital. Health care professionals are bound by privacy laws that restrict their ability to discuss a patient’s health with anyone but the patient, spouse, or the person the patient has designated by power of attorney over health care matters. Having a copy of a POA over Health Care in your possession to place in the medical records which designates you as having POA ensures that all health care professionals who work with your parent/in-law/friend will answer your questions about the patient’s care even if they have to tell you that they do not yet know the answer to your questions.
Important Point #2: If you end up taking a senior to the emergency room as I did my father-in-law, be prepared for a long stay. As the advocate for the patient, you will need to be on hand for the history taking process to point out previous hospitalizations, recent illnesses and to do so for each nurse/doctor/lab tech who comes to the patient’s bed. All the bottles of medications that the patient takes should be gathered and kept with you in a plastic bag for entering into hospital records. So have someone find you a comfortable chair near the patient’s bed and do not switch off with family members until all the tests are done and the doctor finally arrives with a diagnosis. After the attending physician tells you what the diagnosis is, if all the symptoms are not addressed, ask him/her questions. You may need those answers to make informed decisions. You could be there for a long time.
Important Point #3: If the patient is admitted to the hospital from the emergency room, make sure that the hospital staff knows you are to be informed of any change in the status or care of the senior and be sure to put a telephone number in the records where you can be reached 24/7. If there are to be any changes in rooms or any invasive procedures done, especially at bedside, you want to be informed.
(I was horrified to arrive at the hospital one morning to find that my mother was placed in a room with two other patients overnight while preparing for a colonoscopy, meaning she had to walk past the other patients all night to go to and from the bathroom as the detergent she was given to drink cleaned out her system. In addition, the staff planned on having the colonoscopy performed bedside with only a curtain between them and the other patients’ beds. I made sure my mother was moved to a room that had no other patients in it while the procedure was performed. But she needed me as an advocate to take care of her dignity.)
Not all the duties should fall on the family member who has POA. At this point, our family emails back and forth about post hospital care, how Dad is responding to physical therapy, who will take Dad for routine labs (not quite as crucial as the results, unless the technician finds something immediately that becomes an emergency situation) and what to do about Dad’s 91st birthday. We, as a family, are quick to update one another on health issues related to the senior members of the family.
Important Point #4: For serious and critical illnesses or for long distance caregivers, there are professional advocates who can be consulted. Many can be found simply by doing an internet search using the words senior advocacy.
If you are a member of the sandwich generation, looking for further advice, I suggest doing an internet search for articles by Gail Sheehy on caregiving. The most important point she makes in her articles is that caregivers need to take care of themselves. It will not help either you or your loved ones if you are constantly drained emotionally and physically. Learn to pace yourself and to enjoy life’s milestones for yourself and for the seniors you love. Right now, I am looking forward to my mother’s 80th birthday and hoping to have her to cherish for many years to come. Live long, Mom, and prosper.